Provider Demographics
NPI:1992895379
Name:INSPIRA PSYCHIATRIC SERVICES PSC
Entity type:Organization
Organization Name:INSPIRA PSYCHIATRIC SERVICES PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALVERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:VARELA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-704-0705
Mailing Address - Street 1:PO BOX 9809
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-9809
Mailing Address - Country:US
Mailing Address - Phone:787-704-0705
Mailing Address - Fax:787-744-7444
Practice Address - Street 1:TORRE AUXILIO MUTUO SUITE 410
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917
Practice Address - Country:US
Practice Address - Phone:787-296-0555
Practice Address - Fax:787-296-0720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRCASM0268261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0091230Medicare ID - Type UnspecifiedMEDICARE PART B PROVIDER